The Role of Hyperleptinaemia and Low Values of Interleukin 10 in De Novo DSA Production After Kidney Transplantation

Background White adipose tissue secretes a number of peptide hormones. The aim of this paper was to determine the role of leptin, adiponectin and interleukin-10 and interleukin-6 on the development of graft rejection in protocol biopsy after kidney transplantation. Methods In a prospective analysis (n = 104), we monitored the values of leptin, adiponectin, IL-6, and IL-10 prior to the transplantation and in the 3rd month after the transplantation. The protocol biopsy of the graft was performed in the 3rd month after the transplantation. The group was divided into the following according to the biopsy result: negative result, IFTA 1, borderline, and DSA positive. Results After adjusting for the differences in the baseline recipient and donor characteristics, we identified the hyperleptinaemia baseline (HR = 2.0444, P = 0.0341) and month 3 (HR = 49.8043, P < 0.0001) as independent risk factors for borderline changes in the protocol biopsy. The hyperleptinaemia baseline (HR = 7.4979, P = 0.0071) and month 3 (HR = 9.7432, P = 0.0057) are independent risk factors for de novo DSA positivity. A low value of IL-10 month 3 is a risk factor for de novo DSA positivity (HR = 3.0746, P = 0.0388). Conclusions Higher leptin levels and low values of IL-10 might play a role in rejection and de novo DSA production.

Hansen's disease – a forgotten disease?

Hansen's disease, also known as leprosy, is an infection caused by the bacteria Mycobacterium leprae. The authors present the case of a 52-year-old man, born in Tondela and living in Espinho, with no pathological antecedents. The clinical picture began in April 2017, when macular lesions appeared in the lower limbs and rapidly progressed to the trunk and upper limbs, associated with complaints of pruritus but without alterations in the analytical study. After several topical and systemic treatments with glucocorticoids, antifungals, antibacterials and unsuccessful antihistamines, he was referred to an external consultation of Dermatology. He performed a biopsy of one of the lesions that revealed the definitive diagnosis: “Lepromatous Leprosy”. After the biopsy result, he started triple treatment with rifampicin, clofazimine and dapsone with improvement of the condition.

AMELOBLASTOMA ASSOCIATED WITH DENTIGEROUS CYST

Ameloblastoma is a benign, locally aggressive tumour, with an unicystic variant that is very difficult to be differentiated from odontogenic cysts, because of their similarity in the clinical manifestation and X-ray examination. The morphological similarities between these processes make for a more difficult histological diagnosis. We present a case of a 32-year old male, admitted in the Maxillofacial surgery clinic in a University hospital for surgical treatment, because of a swelling in the left mandibular vestibule. A cystic formation, histologically diagnosed as an epithelial one, is removed. Eight months later, the patient is admitted once again, with the same symptoms. The biopsy result from the second operation is a plexiform unicystic ameloblastoma. What is being discussed is the connection between the two pathological processes and the difficulties with giving the correct morphological diagnosis.

Extra-synovial Pigmented Villonodular Synovitis of the knee joint, Case Repor

Background: PVNS is a rare, benign & aggressive disorder arising from either synovial joints or tendon sheaths; it may erode articular structures and bones. We present a case with unique features of PVNS being extra-synovial and by this report we open a gate for more researches in this field. Case Presentation: This case report concerns a 35-year-old female with a history of right knee pain for 6-month duration proceeded by gradual swelling over posterior aspect of the knee, she denies any history of trauma, clinical examination was unremarkable but apart from tenderness over the infrapatellar region with full flexion. MRI shows a heterogenous signal extra-articular and extra-synovial lesion in posterior aspect of the knee suggesting Pigmented Villonodular Synovitis, FNA revealed a hemosiderin-laden macrophages and multinucleated giant cells, Tru-cut biopsy result was suggesting PVNS as synovial cells were seen admixed with hemosiderin-laden macrophages with fibroblastic elements. Through posterior approach; the lesion was surgically excised and histopathological examination confirmed the diagnosis, the lesion was recurrent after 1-year and MRI revealed the same features, the lesion was excised by arthroscopic intervention. Conclusion: We concluded that PVNS cannot be excluded when extra-synovial lesion is assessed, and further researches on this topic will expand our understanding of the etiological and pathological aspects of this tumor.

The role of serological tests and biopsy in the diagnosis of celiac disease: retrospective review of 1137 duodenal biopsies

Background: The aim of this study is to evaluate gluten sensitivity and/or celiac disease (CD) on the basis of serological tests and duodenal biopsy and to draw attention to the prevalence in the population and the correlation between serological tests and biopsy results.Methods: Patients who applied to Health Sciences University Bursa High Specialization Training and Research Hospital between 2015-2019 and who underwent serological tests and duodenal biopsies with a diagnosis of CD or gluten sensitivity were retrospectively analyzed.Results: The study was conducted with a total of 1137 cases, 61.2% (n = 696) of who were women and 38.8% (n = 441) were men. Their ages range from 17 to 91, with a mean of 40.16 ± 16.18 years. Of the 178 patients with gluten sensitivity, 122 (68%) were female and 56 (32%) were male. According to the results of duodenal biopsy, an average of 8% Marsh 3, 5% Marsh 1-2 was detected in the last five years. For the whole study, a significant difference was found between celiac autoantibody positivity rates according to the biopsy results (p = 0.001; p <0.01). The rate of serological test positivity was higher in patients with biopsy result Marsh 3 than those with normal biopsy result, peptic duodenitis and Marsh 1 and 2. No statistically significant difference was found between the rates of Marsh 3 biopsy results and serological test positivity by years (p> 0.05).Conclusions: The number of patients applied with a diagnosis of CD in the last five years has gradually increased (3.4-33.7%). Of the patients with Marsh 3 and Marsh 1-2 biopsy results, 78% were under 50 years old. This suggests that gluten enteropathy in young female patients having digestive system complaints should not be ignored during the diagnosis. Serological test results were highly correlated with the biopsy results in patients with Marsh 3 biopsy results. We think that if clinical findings are supported with serological tests and directed for biopsy in the diagnosis of celiac disease, it will be more cost effective and the workload and time loss will be prevented.

Sarcoma de Kaposi clásico con compromiso gastrointestinal multifocal. Reporte de un caso

Although intestinal involvement occurs in more than half of the cases with KS that are HIV positive, it is uncommon in the classical form, as it occurs in approximately 10% of the patients. We present the case of a 60-year-old male patient with a one-year disease time characterized by having violaceous lesions on the feet and the hands, slightly pruritic and 2 months of epigastralgia and constipation with weight loss of approximately 12 percent of his total body weight. In the physical examination multiple violaceous papule-like lesions are shown on the hands and the feet, some coalescing to form plaques. Laboratory tests revealed a mild normocytic normocytic anemia, the serology for viral hepatitis B and C was negative, HIV negative and ELISA test too. An upper endoscopy was performed and multiple maculopapular and erythematous-violaceous lesions were observed in the esophagus, the stomach and the duodenum. In the colonoscopy, multiple lesions with similar characteristics in the ileum, throughout the colon and in the rectum were recognized. The biopsy result was compatible with the KS in all lesions and it was confirmed with the positive HVV-8 immunohistochemistry. This case highlights the likelihood of presenting GI SK in elderly patients with gastrointestinal compromise and cutaneous findings, HIV negatives as well as the need to realize an adequate discarding by performing endoscopic studies with the biopsies to optimize treatment.